Ahmet DOĞAN, Mehmet ALBAYRAK, Y. Emre AKMAN, Gazi ZORER

Fleksibl pes planovalgusta kalkaneal uzatma osteotomisinin sonuçları ve ayak diziliminin değerlendirilmesi

Amaç: Fleksibl pes planovalgus (PPV) deformitesi olan hastalarda modifiye Evans osteotomisi tekniğiyle uygulanan kalkaneal uzatma ameliyatının sonuçları ve bu tekniğin ayak dizilimini sağlamadaki başarısı değerlendirildi. Çalışma planı: Fleksibl PPV deformitesi olan 11 hastanın (6 erkek, 5 kız; takip sonu ort. yaş 10 yıl 10 ay; dağılım 5 yıl 6 ay-14 yıl 8 ay) 22 ayağına modifiye Evans osteotomisi tekniğiyle kalkaneal uzatma ameliyatı yapıldı. Etyoloji, beş olguda serebral felç, bir olguda miyelomeningosel sekeli, bir olguda herediter sensorimotor polinöropati iken, dört olgu idiyopatik olarak değerlendirildi. Olguların tümü ameliyat öncesinde uzun süreli konservatif tedavi görmüş, bir hasta dışında hiçbir olgu deformite nedeniyle ameliyat geçirmemişti. İki taraflı deformiteler, bir hasta hariç tüm hastalarda aynı seansta ameliyat edildi. Klinik değerlendirmede 10 parametre; standart ön-arka ve yan radyografiler üzerinden yapılan radyografik değerlendirmede yedi parametre göz önüne alındı. Ameliyat sonrası takip süresi ortalama 18 ay (dağılım 13-75 ay) idi. Sonuçlar: Tüm olgularda ortalama 7 hafta (dağılım 6-8 hafta) içinde radyografik olarak kaynama sağlandı. Klinik değerlendirmede 17 ayakta (%77.3) mükemmel, üçünde (%13.6) iyi, birinde (%4.6) orta, birinde kötü sonuç elde edildi. Radyografik değerlendirmede beş ayakta (%22.7) mükemmel, 13’ünde (%59.1) iyi, dördünde (%18.2) orta sonuç elde edildi. Kalkaneusta ortalama 7.3 mm (dağılım 4-9 mm) uzama sağlandı (p

Anahtar Kelimeler:

Kalkaneus, Kemik uzatma, Osteotomi, Radyografi, Ayak deformitesi

The results of calcaneal lengthening osteotomy for the treatment of flexible pes planovalgus and evaluation of alignment of the foot

Objectives: We evaluated the results of calcaneal lengthening using the modified Evans osteotomy technique in patients with flexible pes planovalgus and the effectiveness of this technique in restoring the alignment of the foot. Methods: Calcaneal lengthening osteotomy was performed using the modified Evans technique in 22 feet of 11 patients (6 males, 5 females; mean age at the end of follow-up, 10 years 10 months; range 5 years 6 months to 14 years 8 months) with flexible pes planovalgus deformity. Etiologies were cerebral palsy (n=5), sequela of myelomeningocele (n=1), and sensorimotor polyneuropathy (n=1); four patients were evaluated as idiopathic. All the patients received long-term conservative therapy preoperatively, and, except one patient, none had undergone surgery for the deformity. All patients but one were operated on bilaterally at a single session. Clinical assessment was based on 10 parameters, and radiographic assessment was based on seven parameters on standard anteroposterior and lateral radiographs. The mean follow-up was 18 months (range 13 to 75 months). Results: Radiographically, union was achieved in all the patients after a mean of 7 weeks (range 6 to 8 weeks). Clinical results were perfect in 17 feet (77.3%), good in three feet (13.6%), fair in one foot (4.6%), and poor in one foot. Radiographically, five feet (22.7%), 13 feet (59.1%), and four feet (18.2%) were assessed as perfect, good, and fair, respectively. An average of 7.3 mm (range 4 to 9 mm) of calcaneal lengthening was obtained (p<0.05). Malpositioning of the graft or overcorrection did not occur. Before surgery, five patients could walk on the heel with (n=3) or without (n=2) support; postoperatively, all the patients but one could perform this without support. Conclusion: Calcaneal lengthening osteotomy for symptomatic pes planovalgus provides pain relief and significant clinical and radiographic correction in the hind foot and forefoot

Keywords:

Calcaneus, Bone Lengthening, Osteotomy, Radiography, Foot Deformities,

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